Q. Is it true that Zoledronic acid is better than Ibandronic acid for bone problem?

Q. Is it true that Zoledronic acid is better than Ibandronic acid for bone problem?

Questions

Hi doctor,

My mother is suffering with breast cancer as primary and now there is brain metastasis. The disease has spread to all the parts of the body including the bones. I have attached her PET scan for your reference. We are taking the treatment for the disease and her physical condition was very good till last week. Our doctor got changed suddenly as he moved to another hospital and the new doctor is taking care of her now. Every month we used to have Ibandronic acid for bone, but we did not receive this medicine last month as this doctor did not include it. Now, my mother is getting severe leg pains and not able to sit or get up. She is unable to stand for even 2 minutes. Can you see the PET scan report and suggest good medicine for the bone improvement? Can you suggest a good medicine for bone metastasis? Some doctor said that Zoledronic acid is better than Ibandronic acid. Please suggest.

Answered

Hi,

Welcome to dr.sitehome.info.

I understand your concern about the patient.

As per the scan report you sent (attachment removed to protect patient identity), though the metastasis is widespread, she has relatively improved as far as bone are considered (sclerotic). In case of cancers, bone quality is largely affected. Bisphosphonates are used to improve the quality of bone, which is a slow process. Currently, two approved and commonly used IV bisphosphonates are Pamidronate disodium (Aredia and Novartis) and Zoledronic acid (Zometa and Novartis). This will reduce her bone pain relatively. Her kidney function should be normal before taking this injection. This should be taken once in a month. You can just request the treating oncologist regarding this.

Regarding your query, though there are few differences between them Zoledronic acid is preferred. But, that does not mean that the other bisphosphonate should not be taken. Any bisphosphonate work similarly with each differing in their side effects. She might not be able get up means apart from the bony component, neurological component might be present and her generalized weakness would also add to it.

The Probable causes:

Preventive measures:

1. Use a walker while walking if she has pain while walking to prevent falling. As her bones are weak, even a trivial fall can cause fracture.
2. In the bathroom, use any carpet, which does not slip.
3. Always ask her to take the support of the railing while climbing stairs.